Mortality prediction by SOFA score in ICU-patients after cardiac surgery; comparison with traditional prognostic\u2013models

Abraham Schoe,Evert De Jonge,Ferishta Bakhshi-Raiez,Nicolette De Keizer,Jaap T Van Dissel

doi:10.1186/s12871-020-00975-2

Abraham Schoe, Evert De Jonge + Show 3 more

Open Access

https://doi.org/10.1186/s12871-020-00975-2

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Abstract

BackgroundThere are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative.The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models.MethodsWe investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R2, and Ĉ-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018.ResultsDiscrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor.ConclusionAlthough the SOFA score had a good discriminatory power for hospital- and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models.

Highlights

There are many prognostic models and scoring systems in use to predict mortality in Intensive Care Unit (ICU) patients
The aim of the current study is to investigate, in a large retrospective cohort derived from the Dutch National Intensive Care Evaluation (NICE) registry [11] [12], how well the Sequential Organ Failure Assessment (SOFA) score on day one predicts ICU and hospital mortality in comparison to the general ICU mortality prediction models, i.e. Simplified Acute PhysiologyScore-II (SAPS-II), MPM24-II, APACHE-II, and APACHE-IV
The incidence of ICU mortality and hospital mortality is highest in the quartile with the highest SOFA scores

Summary

Introduction

There are many prognostic models and scoring systems in use to predict mortality in ICU patients. Score-II (SAPS-II) [1], Mortality Probability Model after 24 h-II (MPM24-II) [2], Acute Physiology and Chronic Health Evaluation–II (APACHE-II) [3] and Sequential Organ Failure Assessment (SOFA) score [4] were developed for such purposes but excluded cardiac surgery patients. Some of these scoring systems are used in the cardiac surgery population admitted to the ICU [5] [6]. It would be interesting to know if the SOFA score could predict mortality in the cardiac surgery population as well

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